Whenever a pregnant woman develops macules (maculae), there is a fear that internal steaming of heat toxins may injure the fetus. One should use a formula that clears heat and calms the fetus while simultaneously resolving the exterior, ensuring the fetus is safe and the macules resolve easily. Thus it is said that macules differ from smallpox (variola). Smallpox requires internal fullness; if the fetus is expelled, the mother dies. Macules require internal emptiness; thus even if the fetus is expelled, the mother survives. Although expelling the fetus saves the mother, nothing is better than saving both mother and child. Practitioners must understand this.

A pregnant woman developed macules with intense heat that disturbed the fetus, leading to fetal expulsion and excessive bleeding. Although the macules subsided, she suffered from dryness, fever, restlessness, panting, coma, and suffocation. I diagnosed this as blood depletion. Treatment involved tonifying Qi using Lizhong Tang (Replenish the Middle Decoction) to restore consciousness, followed by Ren Shen (Ginseng Radix) 1 liang, Dang Gui (Angelicae Sinensis Radix) 5 qian, E Jiao (Colla Corii Asini), Pao Jiang (Prepared Ginger Rhizome), Jing Jie (Schizonepetae Herba), and Ai Ye (Artemisiae Argyi Folium), along with symptomatic management, resulting in recovery.

Another pregnant woman developed macules with extreme heat and oppression. The physician administered formulas for clearing heat and calming the fetus, but the heat intensified. I cited *Xin Jian* (Mirror of the Heart): "In cases of pregnant women developing macules where heat remains extreme and unrelenting, it is due to internal excess." The fetus must be expelled to drive out the macule-toxin; once expelled, the internal heat resolves, and the mother's life can be saved. Otherwise, severe heat causing panting and distension will result in the death of both mother and child. The patient did not follow my advice and died as predicted.

A pregnant woman presented with macules, intense heat, lower abdominal pain, and spotting. I attributed this to intense heat disturbing the fetus. She was treated with Shengma Gegen Tang (Cimicifugae et Puerariae Decoction) modified with Jing Jie (Schizonepetae Herba), Zi Su (Perillae Folium), Huang Qin (Scutellariae Radix), Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), E Jiao (Colla Corii Asini), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), and Sha Ren (Amomi Fructus). The bleeding stopped, and she recovered. In other cases where treatment differed from the above, fetal expulsion occurred, resulting in the death of both mother and child, or the death of the child with the mother surviving.

A postpartum woman had difficulty erupting macules, with intense heat and continuous bleeding. I reasoned that postpartum Qi and Blood deficiency prevented the complete external resolution of toxins. She was treated with Mahuang Gegen Tang (Ephedrae et Puerariae Decoction) modified with Dang Gui (Angelicae Sinensis Radix), E Jiao (Colla Corii Asini), Jing Jie (Schizonepetae Herba), Bai Zhi (Angelicae Dahuricae Radix), and Ren Shen (Ginseng Radix). Bleeding ceased, macules fully erupted, and she recovered after conditioning.

A pregnant woman had difficulty erupting macules, presenting with extreme heat, chest oppression, confusion, panting, and distension. I judged the macule-heat to be critical and fatal, making it impossible to save both. Expulsion of the fetus was indicated to save the mother. A formula with exterior-resolving and abortifacient properties was used. After fetal expulsion, the macules erupted, heat subsided, and she recovered.

A pregnant woman developed macules with intense heat, leading to fetal expulsion and dystocia. I prescribed Yu Jiao (Fish Bladder/Chorion? Note: Context suggests a specific material, likely Colla Piscis or similar, translated here as Fish Glue/Collagen based on 'Yu Jiao') 3 cun, burned to ash retaining its nature, mixed with She Xiang (Moschus) 1 fen, ground into powder, and taken with good wine. Delivery occurred immediately. If dystocia was severe, with transverse or breech presentation, 1 chi of Yu Jiao prepared similarly was used; although the fetus would be delivered immediately, it would not survive.

A woman suffered cough after macules, night fever with morning coolness, pale complexion with lack of spirit, emaciation, and red lips. Others attributed this to Qi and Blood deficiency and prescribed Bazhen Tang (Eight Treasures Decoction) without effect. Upon inquiry, I determined she had engaged in sexual activity imprudently after the macules. She was treated with Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) combined with Shengmai San (Generate the Pulse Powder) and advised to live in seclusion for 100 days, after which she recovered.

Another woman engaged in imprudent sexual activity after macules, gradually deteriorating into deficiency, frailty, and emaciation, ultimately dying.

Fa Ban (Eruption of Spots/Macular Rash)

"Ban" refers to spots resembling brocade patterns, red in color and without granular heads. This condition arises from heat toxins stagnating and obstructing, scorching Yin Blood. When blood is heated and cannot dissipate, it floats into the muscles, forming ban, primarily governed by the Foot-Yangming Stomach Meridian. *Huo Ren Shu* (Book of Saving People) states: If shaoyang disease is purged too early, heat enters the stomach through the deficiency, causing ban; if purged too late, heat remains in the stomach, also causing ban; if Yang syndromes are treated with excessive hot herbs, stomach heat causes scorching and rotting, leading to ban. Additionally, internal injury causing extreme deficiency of Stomach Qi allows Fire to wander externally, also causing ban.

Red and vibrant ban indicates a favorable prognosis; crimson ban indicates intense heat toxin; green or black ban indicates an unfavorable prognosis. The treatment principle prioritizes clearing and resolving; sweating methods are contraindicated. Excessive sweating opens the pores excessively, worsening the macular erosion. *Bing Ji* (Pathogenesis) states: Ban and zhen have Yin/Yang and light/heavy distinctions, but all transform via Fire. In acute cases, treat the branch/symptoms; in chronic cases, treat the root/cause. For Yang syndromes, clear heat and transform ban; for Yin conditions, regulate the middle and warm the stomach.